DBW_ABCs_2023

DBW FORM BAR-1 11/17

SIGNATURE DATE

NAME ADDRESS PHONE ( )

PERSON COMPLETING THE REPORT

TYPE OF BOAT

ACTIVITY

BOAT MANUFACTURER BOAT MODEL YEAR BUILT SPEED AT TIME OF ACCIDENT

OVER 100 HOURS AGE MARINA/RAMP LAUNCHED FROM: INFORMATION: VESSEL #2 (OTHER VESSEL INVOLVED) THIS VESSEL ONLY # INJURED # DEAD ESTIMATED DAMAGE RENTED BOAT YES NO # OF PERSONS ON BOARD # OF PERSONS TOWED BOAT NUMBER (CF OR DOC #) MFR. HULL ID # BOAT NAME DEPTH (TRANS. TO KEEL) BEAM WIDTH LENGTH YES NO STATE COURSE INFORMAL NONE OTHER:

INFORMATION: OPERATOR #2 IS OWNER DIFFERENT THAN OPERATOR? YES NO OPERATOR NAME, ADDRESS, PHONE # OWNER NAME AND ADDRESS

RAFT ROWBOAT AIRBOAT OTHER (specify)

CANOE/KAYAK

SAILBOAT (sail only)

HOUSEBOAT PONTOON INFLATABLE SAILBOAT (aux. engine)

OTHER OPEN MOTORBOAT CABIN MOTORBOAT PERSONAL WATERCRAFT

COMMERCIAL

RECREATIONAL

ON BOARD

FIRE EXTINGUISHER

YES NO

HULL MATERIAL

STEEL OTHER (specify)

WOOD ALUMINUM FIBERGLASS PLASTIC RUBBER/VINYL/CANVAS

# ONBOARD

TYPE OF FIRE EXTINGUISHER

FIRE EXTINGUISHER USED

YES NO

INBOARD POD DRIVE OTHER: TOTAL HORSEPOWER: HP NONE

ENGINE TYPE (select one)

PROPULSION (select all that apply)

OUTBOARD STERNDRIVE (I/O)

SAIL MANUAL WATER JET AIR THRUST OTHER (describe)

PROPELLER

LIFE JACKETS ON BOARD

YES NO

MPH

CALIFORNIA BOATER CARD

OPERATOR EXPERIENCE

OPERATION AT TIME OF ACCIDENT

10 TO 100 HOURS

UNDER 10 HOURS

CRUISING CHANGING DIRECTION CHANGING SPEED TOWING SKIER/TUBER TOWING SKIER – SKIER DOWN TOWING ANOTHER VESSEL BEING TOWED BY ANOTHER VESSEL DRIFTING AT ANCHOR TIED TO DOCK LAUNCHING DOCKING/LEAVING DOCK SAILING OTHER (specify)

LIFE JACKETS ACCESSIBLE

# OF ENGINES HORSE POWER

YES NO

QUALIFICATION OF PERSON COMPLETING REPORT

OPERATOR OWNER OTHER (specify)

OPERATOR EDUCATION

USCG AUXILARY US POWER SQUADRON

TYPE OF FUEL

LIFE JACKETS WORN

OTHER:

GAS DIESEL ELECTRIC

YES NO

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